The following information and
photographs explain most aspects of the new non-surgical procedure for
snoring treatment known as Injection Snoreplasty. There
is also some discussion of patient experiences with Snoreplasty in
the discussion forum on this site. As always, you should
consult your doctor as the first step in your snoring
treatment.

What Is Injection
Snoreplasty?

Injection Snoreplasty is a newly
introduced non-surgical procedure to correct snoring due to the flutter of
the soft palate. With Injection Snoreplasty, the soft palate (the soft
tissue in the roof of the mouth ) is injected with a suitable material to
create stiffening of the soft palate. Snoring is reduced by minimising the
flutter or vibration of the soft palate.

How
Does Injection Snoreplasty Work?

The injection agents currently used for snoreplasty
are known as sclerosants. These agents are traditionally used for closing
superficial varicose veins. Investigators of the Injection Snoreplasty
procedure have used a variety of agents including sodium tetradecyl
sulphate (Sotrodecol) and more recently alcohol. Other sclerosant agents
are being investigated for their relative benefits to the reduction of
snoring in the Snoreplasty patient.

Following injection, an inflammatory reaction is
created in the tissues of the patient’s soft palate. During the healing
process, fibrosis of the injected region occurs in which stiffening fibres
of collagen are laid down within the palate. It is this fibrosis process
which stiffens the soft palate and in turn reduces snoring. The healing
changes may take up to two months to finalise.

The very long-term results of the fibrosis are not
known at this stage, as Injection Snoreplasty has been under investigation
for only the last two years. Repeat injections may be helpful if a useful
result has not occurred within the first couple of months of the
Snoreplasty procedure or possibly one to two years after the initial
Snoreplasty procedure should the initial benefits wear off and snoring
symptoms recur.

As Injection Snoreplasty is a newly introduced
technique, the best combination of injection agent, pattern of injection
of the soft palate or the need for repeat injections have yet to be fully
established.

Who Is The Ideal Candidate For Injection
Snoreplasty?

Injection Snoreplasty appears to suit many snorers.

Some 40 to 45% of adults snore of occasion. Some 25%
of the adult population are chronic or habitual snorers. Most snoring is
due to palatal vibration.

Injection Snoreplasty only treats snoring where the
snoring is due to the soft palate. Ideally the best candidate has soft
palate flutter and no other cause. Injection Snoreplasty appears to be a
good technique for women with early snoring and also in men who have
minimum distortion of the soft palate and no additional causes in other
parts of the airway that contribute to their snoring.

Can Injection Snoreplasty
Help Sleep Apnoea Sufferers?

Injection Snoreplasty at this time has no established
role in the treatment of sleep apnoea or snoring related to tongue size or
position. Other surgical techniques or the use of a dental appliance,
known as a mandibular advancement splint or CPAP, an air pressure device,
will be required in such cases.

Can Injection Snoreplasty Be
Used For Children Who Snore?

Injection Snoreplasty at this time does not appear to
have any role in the treatment of children or young infants who snore. In
these patients the most common cause is adenoid enlargement, with or
without enlarged tonsils and in some cases nasal obstruction, typically
associated with nasal allergy. Surgery to remove the adenoids and tonsils
usually cures the snoring problem. Nasal blockage may require anti-allergy
treatment.

How Is Injection Snoreplasty
Performed?

Injection Snoreplasty is a relatively comfortable
through the mouth injection procedure. It mostly causes minimal or short
lasting discomfort.

Injection Snoreplasty requires full ENT specialist
clinical evaluation of the patient beforehand. To determine the
suitability of the procedure and causes of snoring, an assessment of all
contributory causes to snoring must be made.

To improve comfort, two tablets of Paracetemol
(Panadol total 1000 mg) should be taken 30 minutes prior to Injection
Snoreplasty.

The roof of the mouth is initially sprayed with
Lignocaine (Xylocaine 10%) anaesthetic spray. Supplementary Benzocaine gel
to the soft palate may also be applied.

An initial injection of 0.1 cc of anaesthetic
Sotradecol 3% is placed into the soft palate as a test dose for allergic
reactions. The patient is then observed from 15 to 20 minutes. If there is
no allergic response by way of excess swelling, the completion of the
Injection Snoreplasty procedure is then carried out.

The patient generally waits 10 to 15 minutes after
injection to ensure that they are without problem and can then leave the
surgery. The Injection Snoreplasty procedure is generally very well
tolerated.

Photograph of soft palate
immediately after completion of Snoreplasty
procedure

How Long Does The Injection
Snoreplasty Procedure Take To Perform?

The actual injection takes seconds only. However, the
preliminary preparation of the patient including establishing a
"pain-free" anaesthetising of the soft palate, allowing an adequate time
for the observation of allergic difficulty and recovery from the procedure
itself requires approximately 45 minutes.

Is Injection Snoreplasty A
Painful Procedure?

No medical procedure is completely comfortable.
Injection Snoreplasty is usually comfortably tolerated by most patients
provided the initial paracetamol tablets and local anaesthetic technique
for Injection Snoreplasty are used.

In the next few days, some discomfort may be noted
which is in almost all cases relieved by a mild pain reliever e.g. two
tablets of paracetamol from time to time. Discomfort beyond two days is
rare. Some altered sensation of the roof of the mouth due to the volume of
fluid injected and the subsequent tissue reaction may be noted for up to a
couple of weeks. This is mainly noticed when swallowing.

Is Injection Snoreplasty A
Safe Procedure?

Injection Snoreplasty is a new technique and as such
should still be regarded as "under investigation". The preliminary
experience of colleagues around the world has not demonstrated significant
complications or hazards. Few surgeons at this stage have had more than
some dozens of patients. A more extensive experience will be gathered over
the next few years. However, the general consensus is that the technique
of Injection Snoreplasty using Sotradecol has been well accepted without
significant complications emerging.

Sotradecol has been used for many years as a
sclerosant agent for varicose veins in the legs. It has however been used
in other parts of the body and complications appear to be low.

Allergic responses to Sotradecol when used in the leg
have been reported. In discussions with colleagues around the world, such
allergic reactions have not been noted in the soft palate. However,
Sotradecol has been reported as causing a severe allergic reaction known
as anaphylaxis from which death has been reported. This outcome has not
been reported for patients undergoing Sotradecol injection into the soft
palate or Injection Snoreplasty. It is for this reason that a preliminary
test injection is given to all patients to exclude any allergic reaction.
Full resuscitation equipment is kept on hand for any such adverse outcome.
Thus far the initial case load has not revealed any patients with an
allergic response.

What Are The Complications
Of Injection Snoreplasty?

Significant complications from the use of Sotradecol
in the soft palate have not been reported. A direct communication between
various surgeons commencing the use of Injection Snoreplasty technique
around the world has not indicated any patients that have had major
problems. Nevertheless, as in all new procedures, doctors carefully watch
the results and over time complications, if any, are reported from the
experience of increasing number of cases as procedures become more
popular.

Injection Snoreplasty should not be used in pregnant
women, or in any patients who have had previous allergic responses to
Sotradecol used in other parts of the body.

What Are The Early Changes
After Injection Snoreplasty?

The shared experience of this new procedure now
extends in some hundreds of cases and in discussions with other doctors
using this treatment there do not appear to have been any significant long
term complications or reports of significant allergic reaction thus
far.

Some patients may get a white healing area of the
soft palate. The surface lining may be shed or sloughed. This is uncommon
and seems to always heal, without permanent difficulty.

In the early stages after surgery, the consequences
of swelling of the soft palate area may worsen snoring in the initial
after treatment period. Swallowing may be affected. There may be the
sensation of a lump in the soft palate or a sense of mucus adhering to the
surface of the palate and throat, which is rarely a significant
inconvenience and such symptoms are of short duration, settling within
weeks.

In the initial period voice changes may be noted due
to swelling of the palate. This problem does not persist.

Whilst the earlier results of this treatment are
promising from the point of view of minimum complications, no procedure
carried out by a doctor is totally free of the potential of permanent
complications even though in this procedure such a risk would seem to be
extremely rare. Such complications would be the consequence of the healing
tissue changes in the soft palate or reactions to the injected sclerosant
agent.

How Long Do The Benefits Of
The Injection Snoreplasty Procedure Last?

This is a new procedure, with the earliest
international experience being from the year 2000. A number of the earlier
patients continue to show good benefits and satisfactory reduction in
snoring, and this is certainly noticed in the majority of treated patients
properly selected. However, until a five and ten year experience with the
procedure has emerged, it is not possible to at this stage indicate what
the longer term results and their effects on patient snoring will be.

There can be no guarantee that Injection Snoreplasty
will work in any particular patient. Whilst the majority of patients get a
good outcome, as in all other procedures, a certain number of patients
will be unsuccessful. Some of these patients may be assisted by a repeat
injection but not necessarily all patients.

What Are The Benefits Of
Injection Snoreplasty?

In mild selected cases, this new procedure appears to
be generally safe, is relatively painless and quick to perform. The after
procedure experience is very tolerable, with most patients going back to
work the following day. The initial results have been promising and seen
in many cases to equal the results from more complex procedures such as a
laser palatoplasty and radiowave palatoplasty (Somnoplasty).

The procedure may well be unsuccessful where the
causes of snoring are elsewhere in the nose or deeper in the throat, such
as at the back of the tongue. Proper diagnosis following a full history
and examination is essential to the recommendation to performing this
procedure. However even where problems exist in other locations of the
airway, the relative simplicity of Injection Snoreplasty may make this an
intermediate step for temporary partial relief of snoring whilst awaiting
the opportunity for a more extended procedure which may require time away
from work.

What Is The Cost Of
Injection Snoreplasty?

The cost of this procedure will vary according to medical costs
in different countries. For example, in Australia at Dr Lewkovitz’s Sydney
practice, the costs of the Snoreplasty procedure are approximately $A500,
per injection plus relevant consultation fees. A follow up injection may
be required at a later time ranging from two to three months to one year
after the procedure.

The cost of Injection Snoreplasty is not rebated by insurance
funds within Australia at this time.

What Follow Up Appointments
Are Required After Injection Snoreplasty?

In Dr Lewkovitz’s practice, patients are seen one
week after the procedure. If all is going well at this stage, further
follow up is arranged at two months, six months and one year.

In the initial period after treatment, the patient
attends to most basic care.

What
Can I Do About Throat Discomfort
post-Snoreplasty?

After Injection Snoreplasty the throat may continue
to be anaesthetised for up to one to two hours. Care should be taken with
any drinking in this period. The patient can usually return to work or
home unescorted.

Typically mild discomfort of the roof of the mouth
may occur. Some patients do report a more severe discomfort It is uncommon
for this to be for more than one to two days after the procedure and will
be generally assisted by paracetamol tablets (Panadol or Tylenol). As with
all surgical procedures, any pain killing tablets containing aspirin or a
acetylsalicylic acid should be avoided for a two week period after a
surgical procedure because aspirin increases the risk of post surgical
bleeding. Anaesthetic lozenges may be taken if discomfort persists, but
this is usually not necessary. Sucking on ice blocks may be of assistance.
This should be continued until the discomfort is relieved. Cool drinks may
also be of assistance.

Are There Any Special
Precautions With Meals And Fluids?

Most meals will be tolerated but a preference should
be given to softer foods with minimum fibre material that may scratch the
healing throat tissues after Injection Snoreplasty. Hot fluids should be
avoided until the throat settles

When Can I Return To
Work?

Most patients can resume work duties the following
day. Some patients feel well enough to return to work that day. Voice rest
is probably useful over the first one to two days but general
conversational voice use is permitted. A change in voice may be noted in
some patients but these changes are rarely persistent for more than a few
days.

What Do I Do If There Is Any
Swelling Or Infection?

Swelling of the roof of the mouth is a common
experience in the first day or two after Injection Snoreplasty. It usually
settles after this time. Minor changes or awareness of a lump in the
throat or in the roof of the mouth may be noted with swallowing but this
rarely persists. A useful precaution is to elevate the head of the bed
with an extra pillow. This is probably best placed as a cushion underneath
the mattress or the head of the bed can otherwise be tilted upwards.

If there is excessive swelling causing extreme
discomfort or distress relief may be obtained with 10mg per day of
Prednisone or Prednisolone. This medication may be taken for two days if
needed. These tablets should be taken after meals and strictly on your
doctor’s instructions.

Infections are extremely uncommon but should
increasing pain be noted there may be a risk of such a problem, in which
case your doctor should be alerted.